Ultrasound-guided rectus sheath versus subcostal transversus abdominis plane versus quadratus lumborum blocks in laparoscopic cholecystectomy

Objectives We aimed to assess the analgesic efficacy of the ultrasound-guided block of rectus sheath (RS) versus subcostal transversus abdominis plane (TAP) versus quadratus lumborum in laparoscopic cholecystectomy. Background Regional anesthesia has become an essential component of multimodal analgesia to reduce stress-induced physiologic responses. Patients and methods A prospective randomized trial was carried out on 66 patients who were divided into three equal groups, with 22 patients each. Group R received a block of the RS. Group T received a block of the subcostal TAP. Group Q received a posterior quadratus lumborum block. All of them were given a dose of 20-ml bupivacaine 0.25% bilaterally using ultrasound guidance. We assessed the severity of pain postoperatively by the visual analog scale, the time for the first request for rescue analgesia, and the total amount of postoperative ketorolac consumption. Results Group Q had significantly lower visual analog scale score values than the others and group T than group R. Time for the first request for analgesia in group Q was significantly longer than the others and in the T group than in the R group. Ketorolac consumption was significantly lower in group Q than the others and in group T than group R. Postoperative nausea and vomiting were significantly higher in group R than in the others. Conclusion Quadratus lumborum block was the most effective analgesic technique after laparoscopic cholecystectomy compared with subcostal TAP and RS blocks.